Prognostic factors for patients under 45 with colorectal liver metastases following surgical resection: a SEER population-based study
Poster #: 091
Session/Time: B
Author:
Gabrielle Grob, BS
Mentor:
Winifred Lo, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Colorectal cancer (CRC) has been on the rise in adults under the age of 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). βThe aim of this study was to analyze factors associated with disease-specific survival in young patients (<45 years) vs older patients (β₯45 years) with isolated CRLM.
METHODS:
The SEER database was queried for patients with CRLM who underwent primary tumor resection and liver resection from 2010-2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. βCox regression was used to analyze prognostic factors.
RESULTS:
2,828 patients were included in this study, with 391 patients less than 45 years old and 2,427 patients at least 45 years old. Between groups, there was no significant difference in sex, race, income, rural location, T staging or pre-op CEA. Younger patients had more positive regional lymph nodes from primary resection (3.8 vs 3.1, p<0.01). There was a significant difference in chemotherapy and surgery order between groups, with older patients more likely to have received adjuvant chemotherapy and younger patients more likely to have received perioperative chemotherapy. Based on Kaplan-Meier analysis and log-rank test, the younger group had higher overall survival (π2(1)=10.54, p=0.001) and disease-specific survival (π2(1)=7.03, p=0.008) than the older group. In the older group, multiple factors had prognostic value including household income (HR 0.97, CI 0.95-0.99, p<0.01), elevated preoperative CEA (HR 1.34, CI 1.18-1.52, p<0.001), positive regional lymph nodes (HR 1.06, CI 1.04-1.07, p<0.001), and neoadjuvant (HR 0.56, CI 0.41, 0.75, p<0.001) and perioperative chemotherapy (HR 0.30, CI 0.22-0.42, p<0.001). In the younger group, positive regional lymph nodes was associated with lower disease-specific survival (HR 1.03, CI 1.00-1.06, p<0.05), but no other factor had prognostic impact.β
CONCLUSION:
For older patients with CRLM undergoing liver resection, there are a greater number of prognostic factors associated with disease-specific survival as compared to younger patients. Further study is warranted to better understand patient and tumor selection for surgical resection of colorectal liver metastases in young patients.β Limitations include lack of liver information on margins, ablation vs resection, and recurrence-free survival.
Colorectal cancer (CRC) has been on the rise in adults under the age of 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). βThe aim of this study was to analyze factors associated with disease-specific survival in young patients (<45 years) vs older patients (β₯45 years) with isolated CRLM.
METHODS:
The SEER database was queried for patients with CRLM who underwent primary tumor resection and liver resection from 2010-2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. βCox regression was used to analyze prognostic factors.
RESULTS:
2,828 patients were included in this study, with 391 patients less than 45 years old and 2,427 patients at least 45 years old. Between groups, there was no significant difference in sex, race, income, rural location, T staging or pre-op CEA. Younger patients had more positive regional lymph nodes from primary resection (3.8 vs 3.1, p<0.01). There was a significant difference in chemotherapy and surgery order between groups, with older patients more likely to have received adjuvant chemotherapy and younger patients more likely to have received perioperative chemotherapy. Based on Kaplan-Meier analysis and log-rank test, the younger group had higher overall survival (π2(1)=10.54, p=0.001) and disease-specific survival (π2(1)=7.03, p=0.008) than the older group. In the older group, multiple factors had prognostic value including household income (HR 0.97, CI 0.95-0.99, p<0.01), elevated preoperative CEA (HR 1.34, CI 1.18-1.52, p<0.001), positive regional lymph nodes (HR 1.06, CI 1.04-1.07, p<0.001), and neoadjuvant (HR 0.56, CI 0.41, 0.75, p<0.001) and perioperative chemotherapy (HR 0.30, CI 0.22-0.42, p<0.001). In the younger group, positive regional lymph nodes was associated with lower disease-specific survival (HR 1.03, CI 1.00-1.06, p<0.05), but no other factor had prognostic impact.β
CONCLUSION:
For older patients with CRLM undergoing liver resection, there are a greater number of prognostic factors associated with disease-specific survival as compared to younger patients. Further study is warranted to better understand patient and tumor selection for surgical resection of colorectal liver metastases in young patients.β Limitations include lack of liver information on margins, ablation vs resection, and recurrence-free survival.